Adult Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a common, symptomatically heterogeneous, neurodevelopmental disorder. It’s symptoms first appear early in life and evolve as the brain matures and reorganizes over the lifespan. Cognitive dysfunction is a key feature of adult ADHD and typically manifests as a dysregulation of executive control of attention, working memory, inhibitory control, and emotion regulation rather than as a defining deficit in a specific cognitive domain. The heterogeneity of presentation, changing clinical manifestations across development, and variability in functional impairment associated with ADHD contribute to the difficulty of obtaining a “snapshot” diagnosis using a single assessment or representative battery. Careful history-taking of information across raters and settings generally reveals a pattern of symptoms beginning in childhood. Manifested impairment required for diagnosis depends on a variety of supportive or mitigating versus contributory factors. In adulthood, persisted or untreated ADHD may predispose to a variety of other conditions, including low educational and/or academic attainment, decreased earning potential, substance use or abuse, parenting and marital problems, poor health practices, a variety of risky behaviors, and a variety of comorbid Axis I and Axis II psychiatric disorders. High-functioning adults who have not previously come to clinical attention may present for care because of academic underattainment, suboptimal performance in the workplace, or behavioral or mood dysregulation. In addition, ADHD may be discovered as part of a more comprehensive workup of other disorders. A range of psychosocial and psychopharmacological treatments are available; response is often good to excellent once the disorder is properly identified.